Paronychia (Nail-fold Infection)

What is paronychia?

Paronychia is an infection of the skin which is just next to a nail (the nail-fold). The infected nail-fold looks swollen, inflamed, and may be tender. The nail itself may become infected or damaged if a nail-fold infection is left untreated.

What causes nail-fold infections?

• Bacteria tend to cause acute (sudden onset) nail-fold infections which are painful. Pus may form under the skin next to the nail.
• Candida, which is a yeast (a type of fungus), is another common cause. Candida nail-fold infections tend to develop slowly and cause chronic (persistent) infection.
• Other microbes (germs) such as viruses and other fungi are less common causes.

Many nail-fold infections occur for no apparent reason. However, the following can increase the risk of bacteria and other germs getting into the nail-fold skin and causing infection.

• Water. You are more likely to develop a nail-fold infection if your hands are in water for long periods, particularly with detergents. Cleaners, bartenders, beauticians, dish washers, etc, are prone to nail-fold infections. Constant washing may damage the nail-fold and allow infection to develop.
• Injury. For example, nail biting, poor manicure, damaged or diseased nails or nail-folds, etc.
• Covering. For example, if you use gloves for long periods, or use artificial nails, it can cause a moist, airless condition around your fingernails. This is good for some germs to thrive and cause infection.

What is the treatment for nail-fold infections?

• For bacterial infections, antibiotics are usually prescribed. Sometimes pus from a bacterial infection has to be drained by a small cut if it collects next to the nail.
• Candida and fungal nail-fold infections are usually treated with an antifungal cream. Treatment is usually needed for 3-6 months before the infection goes completely and a new healthy nail-fold has formed. Sometimes a course of antifungal tablets or antifungal nail-paint for 6-12 months is needed to clear the infection, particularly if the infection spreads to the nail in addition to the nail-fold.

The following may help to prevent a recurrence of nail-fold infections

• Do not bite your nails or 'pick' at the skin next to nails.
• Keep your hands and feet dry as much as possible. Dry well after washing.
• Wear rubber gloves (preferably cotton lined) if you work a lot with water.
• Do not wear gloves or artificial nails for long periods.
• It is probably best not to have a manicure.

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